Opthalmology Flashcards
Causes of acute red eye
Acute angle closure glaucoma Anterior uveitis Conjunctivitis Scleritis Epi-scleritis Subconjunctivial haemorrhage Endophalmitis Keratitis
S+S acute angle closure glaucoma
Severe pain (ocular or headache) Decreased visual acuity Patient sees halos Semi dilated pupil Hazy cornea
S+S anterior uveitis
Acute onset Pain Blurred vision Photophobia Small fixed oval pupil Ciliary flush
S+S scleritis
Severe pain - worse on eye movements
Tenderness
May be underlying AI condition eg. RA
Most common causes of orbital/periorbital cellulitis
Streptococcus
Staph. aureus
Haemophillus influenzae B
Causes of sudden painless visual loss
Ischaemic optic neuropathy Central retinal vein occlusion Central retinal artery occlusion Vitreous haemorrhage Retinal detachment
S+S ischaemic optic neuropathy
Altitudinal visual field defects
S+S central retinal vein occlusion
Sever retinal haemorrhages on fundoscopy
S+S vitreous haemorrhage
Large -> sudden visual loss
Medium -> several dark spots
Small -> floaters
S+S central arterial occlusion
Afferent pupillary defect
Cherry red spot on pale fundus
S+S retinal detachment
Curtain/veil over vison (from peripheral to central)
Straight lines become curved
Central visual loss
Often preceded by posterior vitreous detachment
S+S vitreous detachment
Flashes in peripheries
Floaters - commonly in temporal area
S+S keratitis
Red painful eye, photophobia, FB/gritty sensation, hypopynon
Causes of keratitis
Bacterial -> S.aureus, P.aeriginosa (in contact lens wearers) Viral -> herpes simplex Fungal Amoebic Parasitic Photo keratitis -> welding Contact lenses
Causes of miosis
Horners syndrome Argyll-Roberston pupil Senile miosis Pontine haemorrhage Congenital Opiates Parasympathomimetics -> pilocarpine Organophosphate toxicity
Causes of mydriasis
3rd nerve palsy Holmes-Aide pupil Traumatic iridoplegia Pheochromocytoma Congenital Topical mydratics -> atropine Sympathomemetics -> amphetamine, cocaine Anti-cholinergics -> tricyclic anti-depressants
Causes of Argyll-Robertson pupil
Diabetes
Neurosyphillis
S+S Argyll-Robertson pupil
Small constricted pupil
Accomodation reflex present; pupillart reflex absent
S+S Holmes-Aide pupil
Dilated pupil (usually unilateral) Slowly reactive to accommodation but very poorly to light
Causes of Marcus-Gunn pupil
Retinal detachment
Optic neuritis
S+S Murcus-Gunn pupil
Affected eye dilated when light moved to it in swinging light test
Fundoscopy features of papilloedema
Venous engorgement Loss of venous pulsation Blurring of optic disc Elevation of optic disc Loss of optic cup Paton's lines = Concentric/radial lines cascading from the optic disc
Causes of pailloedema
Space occupying lesion -> neoplastic/vascular Malignant hypertension Idiopathic intracranial hypertension Hydrocephalus Hypercapnia Hypothyroid Hypocalcaemia Vitamin A toxicity
Cause of tunnel vision
Papilloedema Glaucoma Retinitis pigmentosa Choroidoretinitis Optic atrophy secondary to tabes dorsalis Hysteria
What are angioid retinal streaks?
Irregular dark streaks radiating from the optic nerve head.
Due to degeneration, calcification and breaks in Bruchs membrane
Cause of angioid retinal streaks?
Pseudoxanthoma elasticum Ehler-Danls syndrome Pagets disease Sickle cell anaemia Acromegaly
What is optic atrophy?
Pale well demarcated disc on fundoscopy due to optic neuropathy.
Usually bilateral. Associated with gradual loss of vision
Acquired causes of optic atrophy
MS
Lonstanding papilloedema
Increased intraocular pressure => glaucoma, tumours
Retinal damage => choroiditis, retinitis pigmentosa
Ischaemia
Toxins => tobacco, methanol, arsenic, lead, quinine
Nutritional => B1, B2, B6, B12
Congenital causes of optic atrophy
Freidrichs ataxia
Mitochondrial => Lebers optic atrophy
DIDMOAD
Congenital causes of optic atrophy
Freidrichs ataxia
Mitochondrial => Lebers optic atrophy
DIDMOAD
S+S optic neuritis
Unilateral decrease in visual acuity over hours to days
Poor discrimination of colous => “red desaturation”
Pain worse on eye movement
Relative afferent pupillary defect
Central scotoma
Causes of optic neuritis
MS
Diabetes
Syphillis
Ocular manifestations of RA
Keratoconjunctivitis siccs Episcleritis Scleritis Corneal ulceration Keratitis Steroid induced cataracts Chloroquine retinopathy
S+S retinitis pigmentosa
Night blindness
Tunnel vision
Fundoscopy = black bone spicule shaped pigmentation of peripheral retina & mottling of retinal pigmented epithelium
Conditions associated with retinitis pigmentosa
Usher syndrome Alports syndrome Kearns-Sayre syndrome Abetalipoprotein Lawrence-Moon-Beidl syndrome Refsums disease
S+S Horners syndrome
Miosis
Anhidrosis
Ptosis
Enophthalmos
Site of lesion: Horners with anhidrosis of face, arm & trunk
Central lesion
Site of lesion: Horners with anhidrosis of face
Pre-ganglionic
Site of lesion: Horners with no anhidrosis
Post-ganglionic
Central cause of Horners
Stroke Syringomyelia Multiple sclerosis Tumour Encephalitis
Pre-Ganglionic cause of Horners
Pancoast tumour
Trauma
Thyroidectomy
Cervical rib
Post-Ganglionic cause of Horners
Cavernous sinus thrombosis
Carotid artery dissection
Carotid aneurysm
Cluster headache
S+S blepharitis
Usually bilateral
Grittiness & discomfort
Erythematous/swollen eyelid margins
Styes and chalazions more common
Causes/RF for blepharitis
Meibomian gland dysfunction
Seborrhoeic dermatitis
Staphylococcal infection
Rosacea
Treatment for blepharitis
BD hot compresses
Mechanical removal of debris
Causes of cataracts
Age related Steroids Smoking Excess alcohol Trauma Diabetes Radiation/heat exposure Metabolic disorders
Characteristics for dry ARMD
Drusen -> yellow spots within Bruch’s membrane
Characteristics for wet ARMD
Neovascularisation
Leakage of serous fluid
Haemorrhages
Investigations for ARMD
Slit lamp
Colour fundus photograph
Flourescein angiography
Ocular coherence tomography
Treatment for ARMD
Anti-oxidant vitamin A,C & E
Anti-VEGF MAb
Laser photocoagulation
